PDF(Pubmed)
Abstract：
To describe the extent to which local guidelines for admission to UK midwifery units align with national guidance; to describe variation in individual admission criteria; and to describe the extent to which alongside midwifery units (AMUs) are the default option for eligible women.
National cross-sectional survey.
All 122 UK maternity services with midwifery units, between October 2018 and February 2019.
Alignment of local admission guidelines with national guidance (NICE CG190); frequency and nature of variation in individual admission criteria; percentage of services with AMU as default birth setting for eligible women.
Admission guidelines were received from 87 maternity services (71%), representing 153 units, and we analysed 85 individual guideline documents. Overall, 92% of local admission guidelines varied from national guidance; 76% contained both some admission criteria that were \'more inclusive\' and some that were \'more restrictive\' than national guidance. The most common \'more inclusive\' admission criteria, occurring in 40-80% of guidelines, were: explicit admission of women with parity ≥4; aged 35-40yrs; with a BMI 30-35kg/m2; selective admission of women with a BMI 35-40kg/m2; Group B Streptococcus carriers; and those undergoing induction of labour. The most common \'more restrictive\' admission criteria, occurring in around 30% of guidelines, excluded women who: declined blood products; had experienced female genital cutting; were aged <16yrs; or had not attended for regular antenatal care. Over half of services (59%) reported the AMU as the default option for healthy women with straightforward pregnancies.
The variation in local midwifery unit admission criteria found in this study represents a potentially confusing and inequitable basis for women making choices about planned place of birth. A review of national guidance may be indicated and where a lack of relevant evidence underlies variation in admission criteria, further research by planned place of birth is required.
National cross-sectional survey.
All 122 UK maternity services with midwifery units, between October 2018 and February 2019.
Alignment of local admission guidelines with national guidance (NICE CG190); frequency and nature of variation in individual admission criteria; percentage of services with AMU as default birth setting for eligible women.
Admission guidelines were received from 87 maternity services (71%), representing 153 units, and we analysed 85 individual guideline documents. Overall, 92% of local admission guidelines varied from national guidance; 76% contained both some admission criteria that were \'more inclusive\' and some that were \'more restrictive\' than national guidance. The most common \'more inclusive\' admission criteria, occurring in 40-80% of guidelines, were: explicit admission of women with parity ≥4; aged 35-40yrs; with a BMI 30-35kg/m2; selective admission of women with a BMI 35-40kg/m2; Group B Streptococcus carriers; and those undergoing induction of labour. The most common \'more restrictive\' admission criteria, occurring in around 30% of guidelines, excluded women who: declined blood products; had experienced female genital cutting; were aged <16yrs; or had not attended for regular antenatal care. Over half of services (59%) reported the AMU as the default option for healthy women with straightforward pregnancies.
The variation in local midwifery unit admission criteria found in this study represents a potentially confusing and inequitable basis for women making choices about planned place of birth. A review of national guidance may be indicated and where a lack of relevant evidence underlies variation in admission criteria, further research by planned place of birth is required.
摘要：
描述英国助产单位的当地入学指南与国家指南的一致性程度；描述个人入学标准的变化；并描述助产单位（AMU）在多大程度上是符合条件的妇女的默认选择。
全国横断面调查。
英国所有122个设有助产室的产妇服务机构，2018年10月至2019年2月。
使当地入学指南与国家指南（NICECG190）保持一致；个人入学标准变化的频率和性质；将AMU作为符合条件的妇女的默认出生环境的服务百分比。
从87个产妇服务机构（71％）收到了入院指南，代表153个单位，我们分析了85份个人指南文件。总的来说,92％的本地入学指南与国家指南不同；76％的录取标准既包含“更具包容性”的录取标准，也包含比国家指南“更具限制性”的录取标准。最常见的“更具包容性”的录取标准，发生在40-80%的指南中，分别为：明确接纳胎次≥4的妇女；年龄35-40岁；BMI为30-35kg/m2；选择性接纳BMI为35-40kg/m2的妇女；B组链球菌携带者；以及那些正在引产的人。最常见的“更严格的”录取标准，发生在大约30%的指南中，排除以下女性:拒绝使用血液制品;经历过女性生殖器切割;年龄<16岁;或没有接受过定期产前护理的女性.超过一半的服务机构（59％）将AMU报告为直接怀孕的健康女性的默认选择。
本研究中发现的当地助产单位入院标准的变化代表了女性对计划分娩地点进行选择的潜在混淆和不公平的基础。可能需要对国家指南进行审查，如果缺乏相关证据导致入学标准发生变化，需要按计划的出生地进行进一步研究。
全国横断面调查。
英国所有122个设有助产室的产妇服务机构，2018年10月至2019年2月。
使当地入学指南与国家指南（NICECG190）保持一致；个人入学标准变化的频率和性质；将AMU作为符合条件的妇女的默认出生环境的服务百分比。
从87个产妇服务机构（71％）收到了入院指南，代表153个单位，我们分析了85份个人指南文件。总的来说,92％的本地入学指南与国家指南不同；76％的录取标准既包含“更具包容性”的录取标准，也包含比国家指南“更具限制性”的录取标准。最常见的“更具包容性”的录取标准，发生在40-80%的指南中，分别为：明确接纳胎次≥4的妇女；年龄35-40岁；BMI为30-35kg/m2；选择性接纳BMI为35-40kg/m2的妇女；B组链球菌携带者；以及那些正在引产的人。最常见的“更严格的”录取标准，发生在大约30%的指南中，排除以下女性:拒绝使用血液制品;经历过女性生殖器切割;年龄<16岁;或没有接受过定期产前护理的女性.超过一半的服务机构（59％）将AMU报告为直接怀孕的健康女性的默认选择。
本研究中发现的当地助产单位入院标准的变化代表了女性对计划分娩地点进行选择的潜在混淆和不公平的基础。可能需要对国家指南进行审查，如果缺乏相关证据导致入学标准发生变化，需要按计划的出生地进行进一步研究。
